Stajić Zoran, Mijailović Zdravko, Bogavac Mirjana, Lazović Biljana, Stojanović Maja
Vojnomedicinska akadmija, Beograd Klinika za kardiologiju.
Klinicki centar Vojvodine, Klinika za ginekologiju i akuserstvo, Novi Sad.
Med Pregl. 2013 Nov-Dec;66(11-12):507-13. doi: 10.2298/mpns1312507s.
Nowadays, cardiovascular diseases are the leading cause of maternal morbidity and mortality in the current obstetric practice. PHYSIOLOGICALLY ADAPTED MECHANISMS OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: It is normal that during pregnancy some physiological adaptive changes of the cardiovascular system occur and they may contribute to the deterioration of the clinical cardiac status of a patient with preexisting or acquired cardiovascular disease. The most prominent adaptive mechanisms include the increase of circulating blood volume, decrease of peripheral vascular resistance and decrease of plasma colloid-oncotic pressure. MOST FREQUENT DISEASES OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: Due to these changes, pregnant women are prone to tachycardia, palpitations and peripheral edema. Maternal counseling is obligatory for each pregnant woman in order to decrease the maternal morbidity and mortality. The most important predictors of maternal mortality for pregnant women with cardiovascular diseases are severity of pulmonary hypertension, hemodynamic significance of valvular lesion, cyanosis and functional status in heart failure. Cardiovascular diseases in pregnant women may be congenital or acquired. The most frequent congenital cardiac diseases are atrial and ventricular septal defects as well as persistent ductus arteriosus. These diseases are mainly diagnosed and corrected before the pregnancy, or left untreated if hemodynamically insignificant. The most frequent acquired cardiovascular diseases during pregnancy include arrhythmias, ischemic heart disease, rheumatic mitral stenosis and insufficiency, arterial hypertension and aortic dissection.
In all cases of pregnancy associated with cardiovascular diseases, early recognition of cardiovascular disease is crucial, as well as correct diagnosis and referral to a tertiary centre equipped for a multidisciplinary approach of specialists experienced in high-risk pregnancies and deliveries in order to prevent maternal mortality.
如今，在当前的产科实践中，心血管疾病是孕产妇发病和死亡的主要原因。
孕期心血管系统发生一些生理适应性变化是正常的，这些变化可能会导致患有既往或后天性心血管疾病的患者临床心脏状况恶化。最显著的适应性机制包括循环血容量增加、外周血管阻力降低和血浆胶体渗透压降低。
由于这些变化，孕妇容易出现心动过速、心悸和外周水肿。为降低孕产妇发病率和死亡率，对每位孕妇进行咨询是必不可少的。患有心血管疾病的孕妇孕产妇死亡的最重要预测因素是肺动脉高压的严重程度、瓣膜病变的血流动力学意义、发绀和心力衰竭的功能状态。孕妇的心血管疾病可能是先天性的或后天获得的。最常见的先天性心脏病是房间隔缺损和室间隔缺损以及动脉导管未闭。这些疾病主要在怀孕前被诊断和纠正，或者如果血流动力学意义不大则不予治疗。孕期最常见的后天性心血管疾病包括心律失常、缺血性心脏病、风湿性二尖瓣狭窄和关闭不全、动脉高血压和主动脉夹层。
在所有与心血管疾病相关的妊娠病例中，早期识别心血管疾病至关重要，正确诊断并转诊至配备有经验丰富的高危妊娠和分娩多学科专家的三级中心，以预防孕产妇死亡。
